MedWorm: Appendicitis

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Centers for Disease Control and Prevention. 03/18/2016This guidance provides information about early season mosquito control efforts, which can decrease the risk of eventual Zika transmission. It provides actions to take before mosquito season, during mosquito season, for confirmed transmission (first case, or several cases in a single household or building), for widespread transmission within a county or jurisdiction, and for widespread transmission within multiple counties or the state. An Appendix details how effective mosquito management programs based on Integrated Vector Management (IVM) principles may help prevent the introduction of Zika to an area. (Text) (Source: Disaster Lit: Resource Guide for Disaster Medicine and Public Health)

This article focuses on the etiopathogenesis, clinical behavior, diagnosis and classification of mucinous tumors of the appendix and pseudomyxoma peritonei. (Source: Indian Journal of Surgical Oncology)

Dheda K, Barry C E 3rd, Maartens G. Tuberculosis. Lancet 2016; 387: 1211–26—The appendix for this Seminar has been updated. This correction has been made to the online version as of March 17, 2016. (Source: LANCET)

Stephen FellerHELSINKI, Finland, March 18 (UPI) -- Mild appendicitis can be treated successfully with antibiotics for at least a year, but risk for recurrence of the infection increases sharply after that. (Source: Health News - UPI.com)

Using antibiotics as the primary treatment for mild appendicitis does not increase the risk for complications at least in the first year. But other considerations must also be taken into account, say researchers. (Source: ScienceDaily Headlines)

CONCLUSIONS: The mean quality of labelling is adequate in the majority of clinical trial samples. The lack of essential information in some samples, such as the clinical trial code and the period of validity, is alarming and might be the potential source for dispensing or administration errors.
PMID: 26980166 [PubMed - as supplied by publisher] (Source: Farmacia Hospitalaria)

(University of Helsinki) Using antibiotics as the primary treatment for mild appendicitis does not increase the risk for complications at least in the first year. But other considerations must also be taken into account, say researchers from the University of Helsinki. (Source: EurekAlert! - Infectious and Emerging Diseases)

We analyse two possible definitions of the squashed entanglement in an infinite-dimensional bipartite system: direct translation of the finite-dimensional definition and its universal extension. It is shown that the both definitions produce the same lower semicontinuous entanglement measure possessing all basis properties of the squashed entanglement on the set of states having at least one finite marginal entropy. It is also shown that the second definition gives an adequate lower semicontinuous extension of this measure to all states of the infinite-dimensional bipartite system. A general condition relating continuity of the squashed entanglement to continuity of the quantum mutual information is proved and its corollaries are considered. Continuity bound for the squashed entanglement un...

The objective of this study was to evaluate the incidence of severe hypoglycemia in patients enrolled in Look AHEAD.Research Design and Methods5,145 subjects were randomized to diabetes support and education (DSE) or intensive lifestyle intervention (ILI). Instances of severe hypoglycemia were recorded. (Source: Journal of Diabetes and Its Complications)

Conclusions
Only a small proportion of those with NSAP go on to be hospitalised with underlying bowel pathology. However, their risk is increased even at 10 years after the first hospital admission with NSAP. Diagnostic strategies need to be assessed and refined and active surveillance employed for children with NSAP. (Source: Archives of Disease in Childhood)

in infants and children can be challenging. The symptoms are often non-specific and the majority of conditions are self-limiting. However, it is important to identify the serious life-threatening causes of the acute abdomen and to refer these patients to the appropriate speciality to expedite definitive treatment. We review a structured approach to assessment and define the management of some of the more serious acute abdominal conditions seen in children such as intussusception, appendicitis and malrotation/volvulus. (Source: Paediatrics and Child Health)

We performed a quality improvement initiative to monitor the change in protocol from purely intravenous therapy for perforated appendicitis to oral antibiotics at discharge once patients could tolerate eating. (Source: Journal of Pediatric Surgery)

CONCLUSION: The choice of medical versus surgical management in patients with clearly uncomplicated appendicitis is value- and preference-dependent, suggesting a change in practice towards shared decision-making is necessary.
PMID: 26990957 [PubMed - as supplied by publisher] (Source: The British Journal of Surgery)

CONCLUSIONS: Stigma should be considered in the development of mental health services and research in China, particularly in regard to people with schizophrenia and those at risk of psychosis.
PMID: 26975519 [PubMed - as supplied by publisher] (Source: Psychiatric Services)

This study has numerous limitations related to the model simulations. We do not account for vector control practices in the simulations and thus abundance may be overestimated (as suggested during the off-peak months in Miami and Phoenix in the validation). There is incomplete understanding of how temperature may limit population dynamics at the geographic margins of Ae. aegypti survival68, where sensitivity to poorly-constrained meteorological thresholds may hamper model performance. For example, because knowledge of egg survival during winter in marginal areas is limited68, we artificially introduce eggs into the simulations each month, which keeps eggs from becoming extinct in cities that have seasonal Ae. aegypti populations, but likely causes egg availability/viability to be overestim...

Conclusion
E
. vermicularis was found to be more common in females and those of European descent. Seventy‐seven percent of patients with
E
. vermicularis did not have concurrent acute inflammation of the appendix on histological examination. The question remains as to whether infestation is protective of inflammation or whether infestation causes appendiceal colic and subsequent appendicectomy of a non‐inflamed appendix, thereby protective of the morbidity of acute appendicitis. (Source: ANZ Journal of Surgery)

Conclusion
In uncomplicated appendicitis, SPLA can be performed safely and efficiently. However, more selective indication for SPLA should be applied in cases of complicated appendicitis because of the greater risk of open conversion. (Source: Surgical Endoscopy)

The purpose of this study was to compare rates of ultrasound (US) and computed tomography (CT) for suspected appendicitis at hospitals able to provide definitive surgical care with those from their associated referral hospitals. (Source: Journal of Pediatric Surgery)

In surgical trials, complex variables such as equipment development and surgeons’ learning curve are involved. The evidence obtained in these trials can thus fluctuate over time. We explored the stability of t... (Source: BMC Gastroenterology)

This article is designed to serve as a reference for researchers and clinicians interested in extant evidence-based programs designed to promote healthy youth development. This article begins with a review of 2 freely available online registries of evidence-based youth development programs. Both registries compile information on healthy youth development programs and rate such programs on pre-established criteria. This article also outlines several specific model programs, which intervene on a variety of targets to promote healthy youth development. Lastly, this article also outlines emerging youth development programs. The model and emerging programs reviewed have resulted in myriad positive outcomes. (Source: Child and Adolescent Psychiatric Clinics of North America)

Discussion: ELA avoids misdiagnosis, treats complicated appendicitis at its outset, and avoids complications and/or failure of non-operative treatment of a potentially lethal, diseased appendix. This approach is associated with minimal complications in experienced hands and is a safe and feasible option in children with appendicular mass. (Source: Journal of Minimal Access Surgery)

Conclusions: This double-blind, randomized clinical trial provides evidence that LA for uncomplicated appendicitis is associated with significantly lower oxidative stress compared with OA. Some of the advantages of LA may be attributed to the significant reduction of oxidative stress in these patients. (Source: Journal of Minimal Access Surgery)

Preoperative imaging for suspected acute appendicitis (AA), such as ultrasonography (US), was shown to improve diagnostic accuracy and patient outcomes. Criteria for diagnosis of AA by US are well established and reliable. In previous studies, US assessments were always performed by skilled radiologist physicians. However, a radiologist and computed tomography scanning equipment are not always available in the community hospitals or remote sites of developing countries. (Source: The Journal of Emergency Medicine)

CONCLUSIONS: This review provides low quality evidence that in people with mild to moderate hypertension, beta-1 selective blockers lowered BP by an average of -10/-8 mmHg and reduced heart rate by 11 beats per minute as compared to placebo. The effect of beta-1 blockers at peak hours, -12/-9 mmHg, was greater than the reduction at trough hours, -8/-7 mmHg. Beta-1 selective blockers lowered BP by a greater magnitude than dual receptor beta-blockers and partial agonist beta-blockers, lowered BP similarly to nonselective beta-blockers. Beta-1 selective blockers lowered SBP by a similar degree and lowered DBP by a greater degree than diuretics, angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Because DBP is lowered by a similar extent to SBP, beta-1 selective blocke...

Psychosocial occupational epidemiology has mainly focused on the demandcontrol and, to a much lesser extent, the effortrewardimbalance (ERI) models. These models and the strong focus on them raise some conceptual and methodological issues we will address in the following letter.
The conceptual issues include the empirical confirmation of the assumptions of these models, the extent to which the focus on the demandcontrol and ERI models is warranted, and whether the sub-dimensions of the scales in these models have common health effects. We argue that there is a lack empirical approval of (i) the assumptions behind both models, (ii) the focus on these models, and (iii) the construction of the scales used in the models.
The methodological issues include how exposure to job strain is ...

Conclusions In Sweden, the incidence of appendectomy and acute appendicitis has decreased during 1987–2009. No excess gastrointestinal cancer risks were observed among these appendectomized patients, with the possible exception of esophageal adenocarcinoma. (Source: PLoS One)

Authors: Burr H, Formazin M, Pohrt A
Abstract
Psychosocial occupational epidemiology has mainly focused on the demand-control and, to a much lesser extent, the effort-reward-imbalance (ERI) models. These models and the strong focus on them raise some conceptual and methodological issues we will address in the following letter. The conceptual issues include the empirical confirmation of the assumptions of these models, the extent to which the focus on the demand-control and ERI models is warranted, and whether the sub-dimensions of the scales in these models have common health effects. We argue that there is a lack empirical approval of (i) the assumptions behind both models, (ii) the focus on these models, and (iii) the construction of the scales used in the models. The methodologi...

Devinsky O, Marsh E, Friedman D, et al. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. Lancet Neurol 2016; 15: 270–78—The appendix of this Article has been resupplied to include the correct number of patients at each study site in supplementary table 1. This correction has been made to the online version as of March 7, 2016. (Source: Lancet Neurology)

A 63-year-old man with diabetes mellitus, hypertension, and hyperlipidemia, who had been followed up regularly for 19 years, visited our hospital for positive findings on fecal immunochemical screening test. Although he had no abdominal symptoms, computed tomographic colonography (CTC) was performed for colorectal cancer screening. Colorectal neoplasms were not detected. The CTC showed diverticula in the sigmoid, descending, transverse, and ascending colon as well as in the cecum (Fig. 1a). In addition, five diverticula of 4–6mm diameter were observed in the appendix (Fig. (Source: Digestive and Liver Disease)

CONCLUSION Diagnosis of YP infection may be missed or delayed because it is rare and difficult to detect, and must be distinguished from appendicitis. Although most YP infections are self-limiting, some rare cases will require surgery, therefore early diagnosis is essential. (Source: International Journal of Surgery Case Reports)

Villar J, Giuliani F, Fenton TR, Ohuma EO, Cheikh Ismail L, Kennedy SH. INTERGROWTH-21st very preterm size at birth reference charts. Lancet 2016; 387: 844–45—In the appendix of this Correspondence, the last sentence in the legends for figure 1 and tables 2–4 should have read “Of note, the centiles below 28 weeks (dashed lines) should be interpreted with caution given the small sample size.” The appendix has been updated as of March 3, 2016. (Source: LANCET)

Ovarian hyper stimulation syndrome (OHSS) of the ovary is a medical complication of the ovulation induction and it has shown that OHSS may both mask the typical manifestations of appendicitis and compromise the concurrent intraperitoneal infection. (Source: The American Journal of Emergency Medicine)

The ACR convened a group of over 40 stakeholders (Appendix A) consisting of health care providers, medical specialty societies, industry and other stakeholders to capture opinions and viewpoints regarding the implementation of Section 218(b) of the Protecting Access to Medicare Act (PAMA).
Continue reading » (Source: American College of Radiology)

ConclusionsThe PAMI sheet aids in the collection of a patient's detailed history and objective data with a high level of accuracy, and provides useful referral diagnostic information to the secondary‐level hospitals. This article is protected by copyright. All rights reserved. (Source: Pediatrics International)

We present the normal sonographic appearances of large and small bowel and the sonographic appearances of acute appendicitis, Crohn’s Disease, Coeliac Disease, intussusception, infectious enteritis, intestinal tuberculosis, small bowel ileus and obstruction, small bowel ischaemia and malignant tumours. (Source: Seminars in Ultrasound, CT and MRI)

Conclusions
Our results suggest that OTA is a valid and safe procedure for the uncomplicated cases, while additional trocars are required in case of complicated appendicitis. Multiport HLA significantly reduces the operative time, the incidence of abdominal abscesses and the analgesic requirements compared to OTA. (Source: Surgical Endoscopy)

DISCUSSION: Appendicitis is an important diagnosis in children with cancer, and laparoscopic appendectomy is safe and the procedure of choice.
PMID: 26390529 [PubMed - indexed for MEDLINE] (Source: JSLS : Journal of the Society of Laparoendoscopic Surgeons)

We describe two cases of carcinoid tumor diagnosed in patients who underwent surgery to treat endometriosis, in whom the diagnosis of appendiceal endometriosis was presumed.
DISCUSSION: In the context of endometriosis, surgery is indicated when the appendix is affected. Despite the more likely diagnosis of appendiceal endometriosis, carcinoid tumors cannot be ruled out by imaging examinations.
PMID: 26175555 [PubMed - indexed for MEDLINE] (Source: JSLS : Journal of the Society of Laparoendoscopic Surgeons)

CONCLUSIONS: More than half of EMC patients had other gynecologic lesions including benign and malignant tumors. Surgical lesions were also found in more than one-tenth of patients. Careful pre-operative evaluation and intra-operative inspection are advised for proper management and better prognosis.
PMID: 26925668 [PubMed - in process] (Source: Asian Pacific Journal of Cancer Prevention)

Conclusion Primary omental torsion is a rare diagnosis. A high index of clinical suspicion is required for a preoperative diagnosis. In doubtful cases a CT scan may be helpful. Surgical excision of the omentum remains the treatment of choice; however, conservative management may be attempted in an uncomplicated omental torsion. (Source: International Journal of Surgery Case Reports)

We present the normal sonographic appearances of large and small bowel and the sonographic appearances of acute appendicitis, Crohn’s Disease, Coeliac Disease, intussusception, infectious enteritis, intestinal tuberculosis, small bowel ileus and obstruction, small bowel ischaemia and malignant tumours. (Source: Seminars in Ultrasound CT and MRI)

Following the loss of funding in support of their work, Frans and Anja Helmerhorst have decided to retire from their roles as the Coordinating and Managing Editors of the Fertility Regulation Group. We thank them for their contribution to Cochrane over many years and wish them both well in their retirement.We are therefore looking for a new home for the Fertility Regulation Group: covering systematic reviews of contraception and abortion. The current portfolio of the Group includes 77 completed reviews, 13 published protocols, and 4 titles. Information on the work of the group can be found on its website. Carol Manion, who is currently the group’s Trials Search Coordinator, is willing to stay on in support of the group.REQUIREMENTS We will accept applications from within exist...

We describe a case of isolated acute appendicitis due to Aspergillus carneus in a neutropenic child with acute myeloid leukemia (AML) treated according to the AIEOP AML 2002/01 protocol. Despite prophylaxis with acyclovir, ciprofloxacin and fluconazole administered during the neutropenic phase, 16 days after the end of chemotherapy the child developed fever without identified infective foci, which prompted a therapy shift to meropenem and liposomial amphotericin B. After five days of persisting fever he developed ingravescent abdominal lower right quadrant pain. Abdominal ultrasound was consistent with acute appendicitis and he underwent appendectomy with prompt defervescence. PAS+ fungal elements were found at histopathology examination of the resected vermiform appendix, and galactomanna...

This article briefly reviews the evidence that supports the use of diagnostic tests to reduce the negative appendicectomy rate and examines the potential selection criteria for non‐operative management. The data raises the questions: can a 20–25% negative appendicectomy rate be defended as best practice and can the traditional dogma of early appendicectomy to prevent perforation be supported? (Source: ANZ Journal of Surgery)

U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. 02/26/2016This 14-page document provides Zika virus disease resources and an overview of public health and healthcare system considerations and implications that are applicable to professionals in those systems, emergency management stakeholders, and other audiences. Appendix A contains resources from the U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response and relevant contact links. Appendix B includes citations with annotations for additional relevant resources and Zika guidance. (PDF) (Source: Disaster Lit: Resource Guide for Disaster Medicine and Public Health)

The Harvard-LSHTM Independent Panel on the Global Response to Ebola issued a report1 in The Lancet suggesting reforms to avoid repetition of a similar disaster in the future. The so-called interdisciplinary panel did not see fit to include any members with a background in nursing, despite the essential role of our profession in the global response, our knowledge of operational aspects of public health, and the ongoing sacrifices those in nursing have made at the front lines of the outbreak. (Source: LANCET)

Conclusions
We showed that an acute presentation of a benign neoplasm represents a diagnostic and therapeutic challenge for the surgeon, because of the difficult differential diagnosis that acute presentation can sometimes pose and the trouble that an emergence treatment can imply. (Source: Journal of Medical Case Reports)

Abdominal pain is very common in the pediatric population (<18 years of age). Sonography is a safe modality that can often differentiate the frequently encountered causes of abdominal pain in children. This pictorial essay will discuss the sonographic findings of acute appendicitis, including the imaging appearance of a perforated appendicitis. It will also present the sonographic features of the relatively common mimics of appendicitis, such as mesenteric adenitis/gastroenteritis, intussusception, Meckel diverticulum, and ovarian torsion. (Source: Journal of Ultrasound in Medicine)

We report on a case of a primary appendiceal cancer initially diagnosed as a rectal polyp based on its appearance in the rectal lumen. The management of the patient was in keeping with standard practice for a rectal polyp, and the diagnosis of appendiceal adenocarcinoma was made intraoperatively. The operative strategy had to be adjusted due to this unexpected finding. Although there are published cases of appendiceal adenocarcinoma inducing intussusception and thus mimicking a cecal polyp, there are no reports in the literature describing invasion of the appendix through the rectal wall and thus mimicking a rectal polyp. The patient is a 75-year-old female who presented with spontaneous hematochezia and, on colonoscopy, was noted to have a rectal polyp that appeared to be located within a...

We report a case of a 25-year-old woman with lupus panenteritis. The patient had multiple hospitalizations for abdominal pain, nausea, and diarrhea, initially without any other symptoms suggestive of SLE, but was later observed to have malar rash and oral ulcers. Laboratory investigations were compatible with SLE, including positive antinuclear antibody (1:320) with speckled pattern. CT revealed diffuse hypodense submucosal thickening of the stomach, the entire small bowel, colon, appendix, and rectum. Treatment with high-dose corticosteroids followed by maintenance therapy with mycophenolate mofetil, hydroxychloroquine, and azathioprine resulted in clinical improvement. Diagnosis of lupus enteritis requires a high index of suspicion given the low incidence and nonspecific clinical finding...

In the article “Validating Trauma-Specific Frailty Index for Geriatric Trauma Patients: A Prospective Analysis” by Joseph and colleagues, which appeared in the July 2014 issue of the Journal of the American College of Surgeons, there is an error in the appendix, which includes the Trauma Specific Frailty Index (TSFI) score. The question which assesses the patient for being sexually active contained an error. The corrected online only appendix is reprinted below. The authors apologize for this mistake. (Source: Journal of the American College of Surgeons)

More than 125 years ago, Fitz1 published his autopsy-based observations on acute appendicitis. Three years later, McBurney2 reported that appendectomy for this disease resulted in a 4- to 5-fold decrease in the death rate of 29% without appendectomy. By the 1930s, mortality from acute uncomplicated appendicitis had declined to 0.5%, although mortality remained greater for perforated disease.3 With the introduction of antimicrobials, the mortality and morbidity of complicated appendicitis has dropped as well. (Source: Journal of the American College of Surgeons)

This commentary discusses a cohort study published in JAMA Surgery that investigated the role of shared decision making in nonsurgical vs surgical management of uncomplicated acute appendicitis in children. (Source: JAMA)

In this study, we aimed to histologically reevaluate cases of oral mucoceles to identify possible variants. A total of 667 slides containing tissue sections stained with hematoxylin and eosin diagnosed as a phenomenon of mucus extravasation were analyzed under light microscopy by 4 previously trained examiners. (Source: Annals of Diagnostic Pathology)

We describe traumatic appendicitis in a 7-year-old boy who presented after sustaining blunt abdominal trauma to his right lower abdomen secondary to bicycle handlebar injury. With diffuse abdominal pain following injury, he was admitted for observation. Computed axial tomography (CT) obtained at an outside hospital demonstrated moderate stranding of the abdomen in the right lower quadrant. The CT was non-contrasted and therefore significant appendiceal distention could not be confirmed. However, there was a calcified structure in the right pelvis with trace amount of free fluid. Patient was observed with conservative management and over the course of 15 hours his abdominal pain continued to intensify. With his worsening symptoms, we elected to take him for diagnostic laparoscopy. In the op...

Conclusions
Parental preference of therapy is the most common reason for refusal of study participation. This variable could be influenced with more effective explanation of study rationale and existing equipoise. (Source: Pediatric Surgery International)

Cytomegalovirus (CMV) is a common viral pathogen. Asymptomatic infection or a mononucleosis syndrome are the most common manifestations in otherwise healthy individuals. End-organ disease is rare in immunocompetent individuals. Here, we describe a case of CMV appendicitis in a patient without an immune-compromising condition. (Source: Journal of Clinical Virology)

Pelvic Inflammatory Disease is extremely rare in the premenstrual and virginal adolescent population. In most cases, PID and it’s sequelae, Tubo-ovarian abscess, are secondary to ascending bacterial infections of the vagina and cervix. In the virginal population, the etiology is more commonly secondary to infections of the gastrointestinal and genitourinary tracts. We discuss a case of tubo ovarian abscess in a virginal patient with a history of appendicitis. (Source: Journal of Pediatric and Adolescent Gynecology)

In this presentation, less common causes of acute abdomen are reviewed. Emphasis is on three topics. First, the anatomy of the superior mesenteric vein and mesentery is reviewed, together with the anatomical basis and clinical/radiological presentation of midgut volvulus. Emphasis is on diagnostic clues (whirl sign, abnormal position of cecum, small bowel, and third part of duodenum) and pitfalls (positional variation of small bowel loops with pseudo-twisting of mesenteric vessels). Second, atypical presentations of acute appendicitis and appendagitis, as well as their mimics, are discussed. Finally, an overview is given of uncommon but important causes of free intraperitoneal fluid in patients with acute abdominal pain. Published on 2016-02-16 23:17:36 (Source: Journal of the Belgian Soci...

Conclusion: DD levels increase in patients with AA. Although it does not constitute a useful diagnostic marker, it could be a good prognostic marker.
What is known:
● In pediatric emergency settings, the diagnosis of AA is frequent and can be challenging.
● Laboratory data have taken up an important role, the most useful markers being C-reactive protein (CRP) and leukocyte count, and more controversially, procalcitonin (PCT).
What is new:
● DD ha...

Acute hollow organ ischemia commonly presents with acute pain prompting radiologic evaluation and almost always requires urgent treatment. Despite different risk factors and anatomic differences, ischemia is commonly due to low flow states but can also be due to arterial and venous occlusion. Radiologic diagnosis is critical as many present with nonspecific symptoms. Contrast-enhanced CT is the modality of choice. MRI is preferred in suspected appendicitis in pregnant patients and is superior in biliary necrosis. (Source: Clinical Imaging)

The objective of this study was to compare operative peritoneal irrigation versus suction alone during laparoscopic appendectomy in adult patients; our hypothesis was that the two methods are equivalent in terms of rate of post-operative intra-abdominal abscess. There has been only one prospective, randomized, superiority trial in children, that showed non-significant difference in the rate of intra-abdominal abscess comparing irrigation to suction alone during laparoscopic appendectomy for perforated appendicitis. (Source: International Journal of Surgery)

Conclusion
The normal appendix was seen on MRI in approximately half of pediatric patients, with a mean diameter of ~5–6 mm, variable intraluminal signal characteristics, no adjacent inflammatory changes, and rare surrounding free fluid. (Source: Pediatric Radiology)

Commentary on a study on the outcomes of laparoscopic vs open surgery for appendicitis, published in the British Journal of Surgery. Medscape General Surgery (Source: Medscape Gastroenterology Headlines)

Conclusion: This new tool, ASPECT-R, should provide a reliable, objective way to rate studies along the explanatory-pragmatic spectrum that will better support trial design and facilitate interpretation of completed trials. The complete ASPECT-R tool and guide materials can be accessed online by clicking or visiting this link: http://innovationscns.com/aspect-r-tool-and-training-materials/.
Introduction
Clinical trial designs differ considerably with respect to whether they are conducted under highly controlled and defined conditions (explanatory) or more broadly reflect real world circumstances (pragmatic). These different approaches to trial design are generally aimed at addressing different questions with varying strengths and limitations and differences in extent of generalizability. T...

A thoughtful new analysis of the benefits of reducing public exposure to mercury adds to several studies suggesting that whatever it costs to make those cuts, either under the U.S. Mercury and Air Toxics Rule (MATS) or the international Minamata Convention, it's worth doing. But like that entire body of work, this new analysis is based on a controversial assumption about just how much harm mercury does in the first place. It turns out that this widely known and feared environmental bogeyman might not be as serious a danger as this new study suggests, which the environmental and science media are mostly failing to report. The study, by Amanda Giang and Noelle Selin of MIT, (summarized for non-academic speakers here, in full here) adds up all the health damage mercury is believed to do and a...

We present a 63-year-old-women who had a sessile papillary villous tumor in urinary bladder. Although transurethral resection of the bladder tumor (TURBT) was performed, the villous tumor repetitively recurred and gradually spread to the entire surface of bladder lumen. Histopathologic and immunohistochemical examination showed that the lesion was very similar to low-grade mucinous neoplasm arising in appendix vermiformis. There are no reports on appendiceal metaplasia of urinary bladder mucosa. In this case, we describe this unprecedented neoplasm as “villous tumor of the urinary bladder resembling low-grade mucinous neoplasm of the appendix.” (Source: Urology Case Reports)

A 39-year-old woman was admitted to our hospital with back pain for 9 months.The patient had no neurologic deficit.Plain radiograph and Computed tomography demonsrated a 8.8×5.7cm soft tissue mass which involves adjacent vertebraes and 9th rid in the T9-T10 left paravertebral space(Figure 1). Magnetic resonance imaging showed a lobulated heterogeneous tumor compressing the spinal cord through the left neural foramen(Figure 2).PET-CT scanning indicated desstuctive mass lesion at the left vertebral body and appendix of T9 and T10 with a calculated SUV max value of 9.9(Figure 3).At this time a posterior tumorectomy and fixation-fusion from T8 to T12 was performed.And pathological biopsy diagnosis was giant cell tumor of tendon sheaths. (Source: The Spine Journal)

Abstract
Acute appendicitis (AA) is a common abdominal emergency with a lifetime prevalence of about 7 %. As the clinical diagnosis of AA remains a challenge to emergency physicians and surgeons, imaging modalities have gained major importance in the diagnostic work-up of patients with suspected AA in order to keep both the negative appendectomy rate and the perforation rate low. Introduced in 1986, graded-compression ultrasound (US) has well-established direct and indirect signs for diagnosing AA. In our opinion, US should be the first-line imaging modality, as graded-compression US has excellent specificity both in the paediatric and adult patient populations. As US sensitivity is limited, and non-diagnostic US examinations with non-visualization of the appendix are more a rule...